AGENCY MISSION STATEMENT - Oklahoma Senateappropriation.oksenate.gov/SubHuman/Agencies/2013/FY14... · 2013. 1. 17. · AGENCY MISSION STATEMENT: We help individuals and families

Oklahoma Senate Committee on Appropriations

2013-14 Performance Report

Oklahoma Department of Human Services

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AGENCY MISSION STATEMENT:

We help individuals and families in need help themselves lead safer, healthier, more independent and productive lives.

Adopted by the Human Services Commission June 12, 2007.

LEAD ADMINISTRATOR: Edward Lake, Director Sequoyah Memorial Office Building PO Box 25352 Oklahoma City, OK, 73125-0352 405-521-6462 GOVERNANCE: Passage of SQ 765 led to the abolishment of the Commission for Human Services (Commission) and the implementation of HB 3137 (2012). Responsibility for governance of the Oklahoma Department of Human Services (OKDHS) is now vested with the Director of Human Services (Director) who is appointed by the Governor with Senate confirmation. Four citizen advisory panels were created to evaluate core program and administrative areas and to provide advice, information, findings and analysis to the Director on policies and procedures. The four panels are established for: Children and Family Issues, Aging Issues, Disability Issues, and Administration. Following the February 28, 2012 retirement of Director Howard Hendrick, the Commission completed two nation-wide searches for a new director, one conducted by the agency and another through an outside executive search firm. Both searches recommended the selection of Ed Lake, a former assistant commissioner of the Tennessee Department of Human Services. Lake began serving as the new Director of OKDHS on November 1, 2012.

GOVERNANCE ACCOUNTABILITY: OKDHS adheres to the applicable laws.

MODERNIZATION EFFORTS: Please provide a listing of all government modernization efforts undertaken by the agency since July 1, 2010. Additionally, please provide any authorizing statutory changes that prompted the modernization efforts and whether those efforts have led to cost savings or additional cost burden. Agency Reorganization Upon passage of House Bill 3134 (2012) which mandated the elimination of the Field Operations Division (FOD) and the vertical integration of all program divisions and staff, the FOD was eliminated effective January 1, 2013. FOD staff moved to Child Welfare Services (CWS), formerly Children and Family Services




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Division or Adult and Family Services (AFS), formerly the Family Support Services Division. This reorganization allocated 4000 front-line workers to either CWS or AFS and creates direct-line authority from the decision-maker to the senior executives responsible for the division. Pinnacle Plan The Commission met on January 4, 2012 and approved a settlement agreement in the DG vs. Yarbrough case, a federal class action civil rights lawsuit involving Oklahoma's child welfare system. On March 30, 2012, OKDHS submitted a first draft of an improvement plan for its child welfare program to a panel of three child welfare experts who will be monitoring the state’s improvements over the next five years. OKDHS agreed in the settlement to make targeted performance improvements related to the way it cares for children in foster care. July 1, 2012 marked the official start date of Oklahoma’s Pinnacle Plan. The final draft of the Pinnacle Plan was “endorsed” by the co-neutrals on July 25, 2012. A proposed plan for baselines, targets, and measures was submitted on October 8, 2012. Although official “approval” has not been granted, diligent and thoughtful work to implement the plan and to achieve targeted outcomes has begun. Community Engagement As part of vertical integration, OKDHS is seeking to improve community engagement by coordinating outreach to the faith-based community and recruitment of volunteers through a central office. OKDHS is in the process of developing a strategic plan for community engagement, collaboration and partnerships. The agency currently partners with a variety of faith-based and community organizations to help individuals and families in need. The strategic plan will better align efforts, more effectively leverage resources and improve collaborative efforts with faith-based and community organizations. AFS county directors are being asked to engage their communities and look for opportunities for new and improved partnerships. INFORMATION TECHNOLOGY (IT) CONSOLIDATION As of September 16, 2012, the transfer of 294 funded IT positions from OKDHS to the Office of Management and Enterprise Services, Information Services Division (OMES/ISD) completed IT consolidation as mandated by House Bill 1304 (2011). No state agencies are permitted to keep a Chief Information Officer (CIO), so that position for the agency was eliminated. Data Services Division is now the Office of Service Management and has the responsibilities of:

Ensuring the quality and accountability of service from OMES/ISD is maintained;

Serving as the single point of contact for all OKDHS or agency IT services;

Overseeing the relationship between OKDHS and OMES/ISD, including managing the service level agreements and memorandums of understanding;

Reconciling OMES/ISD invoices;

Managing the $40 million spent for OKDHS IT;

Conducting IT project portfolio management and prioritization; and

Driving innovative ideas through technology.




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Key Government Modernization Efforts by OKDHS Division

Adult and Family Services (AFS) AFS is responsible for administering the following programs: Adult Protective Services (APS), AIDS Coordination and Information Services (ACIS) case management program, Child Care Subsidy, Low Income Home Energy Assistance Program (LIHEAP), SoonerCare (Medicaid) eligibility for the aged, blind, and disabled population, State Supplemental Payment (SSP), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). The AFS director and senior leadership are building processes and procedures to incorporate programs and field staff so all AFS staff are working with the same shared direction and purpose. Reorganization offers an opportunity to reexamine business practices to bring statewide consistency to customer service and efficiency to work processes. For example, AFS senior staff will be visiting small, medium, and large county offices to observe how personnel interact with clients from the time they walk through the door, conduct interviews, request documentation, and approve or renew benefits. This bottom-up analysis will help communicate and standardize best practices in all offices. It also enables senior staff to visit with front line and supervisory staff to examine personnel issues that may contribute to staff turnover and dissatisfaction. APS System Enhancement The Adult Protective Services (APS) System Enhancement is an innovative technology solution that assists in tracking and reporting the allegations of abuse, neglect, and exploitation received by OKDHS. Reported incidents of abuse, neglect, self-neglect, or exploitation are entered into the system by any OKDHS employee. The allegations are reviewed by supervisors and assigned to workers for timely investigations and resolution. This system continues to be enhanced to assist program planners and managers allocate appropriate resources to meet the demands of the APS program. In 2012, a statewide remote functional pilot began that allows an APS specialist to check a case out of the system on a secure and encrypted mobile device where they update investigation interviews and assessments and check it back into the system upon return to the office. This decreases the amount of after the fact transcription and time needed to get critical incident information into the decision making system. Finance Division Process Effectiveness Outcomes OKDHS won the premier Supplemental Nutrition Assistance Program (SNAP) Director's Soaring Eagle Award for five consecutive years from 2007 through 2011. This award was given during the annual Tri-Regional conference by the Regional Director of the United States Department of Agriculture (USDA) Food and Nutrition Services (FNS) Southwest Region for achieving the highest combined points for SNAP access, customer service, and most improved in payment accuracy, negative actions, and program integrity. The Region includes Texas, Arkansas, Louisiana, Oklahoma, and New Mexico. The USDA-FNS did not hold the annual Tri-Regional conference in 2012 and no state awards were given. In 2009, OKDHS also received the Excellence in Initial Budget Projection award and the Quality Control Star award. OKDHS Electronic Payment Services has been recognized nationally and within the state for its process effectiveness, innovation, efficiency, and cost savings and was awarded an "Outsourcing Excellence Award" by the Everest Group and Forbes in 2011.




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OKDHS Live! AFS is faced with the challenge of determining eligibility for federal and state benefit programs while managing increased workloads and meeting high standards for quality, accuracy and timeliness. OKDHSlive! is a people, process, technology and information business model enhancement for eligibility determination. The OKDHSlive! website has been deployed for over a year and is the primary method of benefit renewal for ongoing service delivery. OKDHSlive! promotes quality customer self-service, supports consistent near real-time decision making and preserves face-to-face interaction when staff presence will add the most value for individuals and families in need. AFS uses three regional support centers staffed by OKDHS social service specialists to centralize as many routine business processes as possible. The support centers are supplemented with one state-wide customer service center designated as first responders for clients assistance with OKDHSlive! processes. The OKDHSlive! tools provide the ability to quickly shift workloads as needed and allow for more flexible response to workload management. This OKDHSLive business model gives AFS the: capacity to meet the increased number of applications by sharing caseloads across county and

regional boundaries;

increased use of eligibility automation and management of work flow to allow workers to focus

more on family outcomes;

decreased need for double-filled positions as workloads are concentrated and tasks are specialized;

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greater client satisfaction and service.

OKDHSLive also serves the long-term strategic objectives of making our services more accessible to current and potential clients with a focus on multiple citizen channels or paths that enable improved customer service to working parents and families making our services more family, work and community-centric and less welfare-centric. The OKDHSLive processes position AFS advantageously for deployment of other efficiency boosting functions such as electronic signature which reduces the need to exchange hard copy documents and reduce processing time currently taken up by this exchange. Also, the electronic uploading of verification documents to a one hundred percent digital case file archive was deployed in November, 2012. Using internal resources to modify and deploy an established web application obtained without cost from another government entity, OKDHS was able to quickly and effectively integrate self-service capabilities into existing systems. Along with the accompanying changes in business process, this cost-effective use of technology has enabled the transformation of the service delivery model.

Aging Services Division Aging & Disability Resource Consortium (ADRC) Initiative Oklahoma’s ADRC initiative was established to strengthen the aging and disability resource networks in Oklahoma. A major goal of the initiative is creating an online resource directory that provides statewide long-term care resources for the aging and disabled populations. Under the Aging Services Division’s (ASD) guidance and oversight, testing of the innovative system has been underway during the latter part of 2012. The system is currently in final production with a release date for public use in summer 2013.




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After its release, consumers will have better access to needed services, support for long-term care and help with living in the community independently. Waiver Management Information System (WMIS) Redesign ASD’s WMIS is the IT infrastructure that facilitates ADvantage Program services. The services provided to every ADvantage consumer must be authorized by OKDHS and this system the authorizes and tracks services. Although the existing system has been used since the ADvantage Program started in 1994, OKDHS has continued its extensive efforts this year to review and redesign the system, chiefly evaluating whether an “off the shelf” product could be a better (time, cost, etc.) option than a fully customized redesign. More than 20,000 people each year rely on these services as an alternative to nursing home care. The redesign will also include a new “provider portal” access for service delivery providers which will virtually eliminate the transmittal of paper documents by mail or fax, thus improving the delivery of services and creating a greater process efficiency. It will also improve quality assurance and reporting functions which will enhance quality and accountability. Adult Day Health Electronic Benefits Transaction (EBT) initiative ASD EBT has not only modernized, but also streamlined the processing of claims payment and reporting for the Adult Day Health centers and for ASD. The implementation of this initiative for the 34 providers from manual to electronic reporting lessens paperwork, increases cash flow, and allows these providers to review transactions, and print reports for boards and sponsoring agencies with ease. This change also permits ASD staff to devote more time to program issues rather than focusing on laborious funding and claims procedures. ASD serves approximately 450 OKDHS eligible individuals with state funding to attend these for-profit and not-for-profit Adult Day Health Centers with a duplicated count of over 1,000 individuals. Most people who use this program attend several days if not all days of the work week. Health Promotion and Disease Prevention Programs (HPDP) The aging network in Oklahoma has been moving towards evidence-based HPDP programs for the past several years. Effective February 16, 2012, congressional appropriations required ASD older Americans Act (OAA) Title IIID funding to be used only for programs and activities that have been demonstrated to be evidence-based. Utilizing a three-tiered assessment, based on the history of the program and the degree of change needed to transition to the optimal-level of evidence-based implementation, each program in the state was re-assessed. The ultimate goal is for all Title IIID activities to move toward the highest-level criteria tier, which includes having undergone experimental or quasi-experimental design, full implementation having occurred in a community site and dissemination products having been developed and available to the public. Legal Services (LS) Reporting Improvement initiative ASD LS developer is involved in developing a streamlined system for assessments of LS provided to older Oklahomans throughout the state. Currently, 11 different assessment tools are utilized by each of the 11 Area Agencies on Aging (AAA). Under the new process, use of a streamlined, singular assessment tool will result in a more uniform, modernized and efficient method of evaluation, saving both time and money.




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Child Welfare Services On-line Foster Parent Application Child Welfare Services will complete two additional technology solutions to improve efficiencies for Oklahomans interested in being foster parents and the matching process of families with children. By June 30, 2013, OKDHS will develop an online application process for individuals interested in becoming foster or adoptive parents. This will provide an easier way to apply and also reduce inefficiencies from lost paperwork, copying, and time lost in transferring documents between offices and individual workers. By June 30, 2013, OKDHS will develop and implement a system to match children’s needs with the capacities of families to meet those needs. This system will provide for better matching of the child’s needs with the parents who can meet those needs for example, matching children with a family who lives in their same school district or has an understanding of their special needs. This will be a computer matching process and available statewide for all workers to utilize. Mobile Devices for Child Welfare Staff Child welfare specialists conduct field visits to ensure the safety of children, visit families, and approve foster parents. To improve access to critical information and other tools valuable to ensure their safety along with the children they serve, OKDHS is providing updated technology such as tablets and/or smart phones to all child welfare specialists by June 30, 2013. When conducting home visits, immediate access to email, GPS, directory assistance, the web, a camera, emergency numbers and other applications will greatly enhance their work and services offered to children and families. Timely Permanency for OKDHS Custody Children and Youth Efforts to decrease the time it takes to achieve permanency for children in out of home care have been identified on the Oklahoma Pinnacle Plan. A request for proposal has been drafted to identify a provider who will assist with intensive case management services for older youth with permanency challenges. The Oklahoma Trauma-Informed System Implementation is underway. Trauma-informed assessments and services for children and families are anticipated to reduce the time it takes for permanency goals to be achieved. Progress has been made on the goal of ending secondary assignments for child welfare workers visiting children placed outside the county of jurisdiction. The assignment of a single child welfare worker to children and parents will improve engagement with families and service delivery. This initiative began with ending secondary assignments in contiguous counties with the goal of ending all secondary assignments by July 1, 2013.

Developmental Disabilities Services Division Developmental Disabilities Services Division (DDSD) Client Contact Manager (CCM) DDSD is implementing modernizations to existing systems to allow staff and providers to perform their jobs more effectively and productively. CCM is being converted to a web-based system with an upgrade to the database SQL 2008. CCM is the official client record for waiver service recipients who receive services administered through DDSD. An interface between CCM and Information Management Systems (IMS) is being developed to streamline the performance of the two systems. IMS is the system that maintains client and provider information and generates the authorizations for services and payments to providers. DDSD Online Incident Reporting Initiative Implementation of the DDSD Provider Reporting System provides an internet portal for providers to access the DDSD system to report allegations of abuse, neglect or exploitation.




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Finance Division Direct Cost Certifications OKDHS recently completed an initiative to automate the process of certifying the activity of staff dedicated to certain federal programs. This initiative allows the OKDHS Cost Accounting and Revenue Enhancement Unit to electronically obtain employee certifications necessary for federal grants that have a large federal reimbursement due to the program having 100 percent employee dedication to the grant program. The employee certification was a manual process that took 79 days (2 ½ months) and is now completed in approximately two weeks. Because of the reduction in time obtaining the direct cost certifications, OKDHS is now able to focus resources used in this process on additional cost allocation documentation and reporting requested by OKDHS federal partners. Reduction of Paper Warrants Paper warrant issuance to vendor and clients has been the primary payment method for both OKDHS client benefits and vendor payments. Utilization of paper warrants has an increased manpower requirement, delayed disbursement of benefits and payments, and a higher chance for fraud due to ease of forging a paper document compared to direct electronic payments. By working with other divisions and vendor-partners to accept payments through direct deposit or debit cards, the OKDHS Finance Division has reduced paper warrants to 0.5 percent of all benefit disbursements. Finance plans to eliminate paper warrant issuance for Child Support, Family Assistance, and Respite Vouchers by December 2012 with the remaining paper warrants eliminated by July 2013. The elimination of paper warrants will greatly reduce the chance of fraud, allow repurposing of personnel to more critical OKDHS areas and provide for a more timely benefit distribution.

Office of Client Advocacy The Office of Client Advocacy (OCA) provides assistance, conducts investigations and maintains grievance programs to promote client safety, independence, and the delivery of OKDHS programs or services in a fair, honest and professional manner. After a year-long search in early October, 2012, OCA welcomed a new Advocate General, Kathryn Brewer. OCA provided quality advocacy services to over 1,100 Oklahomans with developmental disabilities in 2012. Advocacy The Advocacy Unit developed and implemented ongoing training to service providers and families to inform them of OCA’s special advocacy services and grievance programs that are available to all Oklahomans receiving Developmental Disabilities Services Division (DDSD) services. The Advocacy Unit also developed a group of specially trained advocates to assist with the Individual Education Plan (IEP) process in public schools. OCA’s special advocacy program continued to grow in 2012 as word of the program spread. In 2012, OCA advocates statewide recovered over $80,000 for our clients from DDSD contracted provider agencies who had mismanaged client funds. During the latter part of 2012, the Advocacy Unit developed plans, in conjunction with DDSD, to successfully transition all of the residents from the Southern Oklahoma Resource Center (SORC) and the Northern Oklahoma Resource Center (NORCE) into community placements. The transfers are an ongoing endeavor that will be monitored and refined as the process is implemented in 2013.




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Grievance OCA has been commissioned to oversee and implement a grievance program for OKDHS custody children, foster parents, and vulnerable adults established by Title 10A. The purpose of OCA grievance policies and procedures is to provide clients a fair, simple, effective, and timely system of problem resolution with access to procedures through which clients can obtain a thorough review, fair consideration, and correction when appropriate. These policies also ensure that persons filing grievances are free from restraint, coercion, reprisal, or discrimination. In Fiscal Year 2012, the OCA Grievance Unit focused on monitoring of grievance programs within OKDHS, child care providers for child welfare and DDSD contract providers. OCA monitors the local level grievance programs for approximately 325 different outlets both internal to OKDHS and contractors. As a result of the increased monitoring efforts, programs within OKDHS excelled from a reporting rate of approximately 50 percent in 2011, to greater than 85 percent, and some with areas greater than 90 percent. The 2012 data revealed that more grievances were filed and reported to OCA with less of those grievances being processed at the contested level. 2931 grievances were filed and reported to OCA with 16 being processed at the contested level, Grievance and Abuse Review Committee (GARC) level, and OKDHS Director’s level. In Fiscal Year 2011, there were no grievance surveys completed or a deficiency written on local programs servicing custody children or vulnerable adults. However, in 2012, OCA conducted surveys throughout the state and issued 824 deficiencies for policy violations. The policy violations included, but are not limited to, advising clients in writing of the grievance program, not following policy requirements for processing, and the training of the Local Grievance Coordinators not being current. Investigations The OCA Investigations Unit in Fiscal Year 2012 received 2,453 referrals and conducted 1,000 investigations, including allegations of abuse, neglect, sexual abuse, sexual exploitation, caretaker misconduct, verbal abuse, financial exploitation, and financial neglect. Investigations were conducted involving clients at the Robert M. Greer Center, NORCE, and SORC. Additionally, investigations occurred involving vulnerable adults, including those who received: DDSD in home support waivers; and Medicaid personal care assistants. Investigations were also conducted with out-of-home placement OKDHS custody children and non-state custody children such as parental custody children, Oklahoma Office of Juvenile Affairs custody, and tribal custody children. The OCA Investigations Unit also investigated foster care retaliation allegations, and completed OKDHS administrative reviews involving child deaths or near-deaths at the request of the Director. In Fiscal Year 2012, OCA also monitored the caretaker misconduct program, and 986 caretaker conduct reviews from facilities were reviewed and approved. Some significant programmatic changes were implemented by OCA in 2012. In July, 2012 the Investigations Unit began investigating all vulnerable adult allegations, with the exception of self-neglect allegations, from Adult Protective Services (APS). Currently OCA is working with APS to ensure the safety and well-being of vulnerable adults. Additionally, OCA Investigations Unit was immersed in the development of policy and procedures to fully implement the requirements of the Pinnacle Plan. OCA has worked jointly with Child Welfare Services to create a system for timely responding to allegations of abuse and neglect of children in out-of-home placements, other than traditional foster care, within priority guidelines. A safety assessment tool was developed and is being utilized by OCA and the Specialized Placement Unit of Child Welfare Services. In December, 2012, the OCA Investigations Unit




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implemented a pilot project to create a specialized Children’s Investigation Division to begin the process of being in full compliance with the Pinnacle Plan’s requirements by June 30, 2013.

Office of the Inspector General The Office of the Inspector General (OIG) oversees and preserves the integrity of OKDHS programs and services through prevention, detection and prosecution of fraud, waste or abuse by OKDHS clients, vendors, employees or the general public. In the last year, OIG has worked to utilize technology to promote more efficient business practices and more accountability of public funds.

The OIG Administrative Review Unit began requesting that all quality control sample cases be scanned into the OKDHS imaging system instead of having the physical case file mailed to OIG. This has eliminated the possibility of case files being lost in transit and has reduced costs associated with mailing the physical files. The OIG Investigations Unit continues to utilize interstate data matching tools to identify and investigate clients who may be violating federal regulations by receiving duplicate benefits in more than one state concurrently. Over the next few years, OIG will be working with Adult and Family Services (AFS) to expand access to data matching information by implementing an automated alert system.

Oklahoma Child Care Services Child Care Restricted Registry Section 405.3 of Title 10 of the Oklahoma Statues mandated the registry be implanted by July 1, 2010. OKDHS created rules to establish and maintain a child care worker registry, accessible to the public and individuals working in the facility through an on-line database. The automated system avoided potential costs of $95,000 for staffing to maintain a manual system. Fingerprint Implementation Oklahoma Child Care Facilities Licensing Act was amended by Senate Bill 674 in 2011 to require criminal history records searches that include fingerprinting of program owners, entities and operators, program directors, employees, and adult residents in facilities. Oklahoma Child Care Services (OCCS) is implementing the legislation in November, 2013. The fingerprinting process includes “rap back”, a notification from the Oklahoma State Bureau of Investigation to OKDHS of subsequent criminal activity by individuals whose criminal background checks were completed pursuant to the requirements of the Oklahoma Child Care Facilities Licensing Act. “Rap back” is a savings for individuals working in child care as they only submit fingerprints one time prior to working in a program. Oklahoma Professional Development Registry OCCS recently implemented out the Oklahoma Professional Development Registry located at http://www.okregistry.org. This registry is a web-based statewide data base where early childhood educators register training opportunities and child care teachers locate and register for training. Quality Rating and Improvement System (QRIS) policy was revised to include criteria requiring teachers caring for children in programs to become Registry participants. Once all educators and child care teachers are registered and training is tracked, the data base will provide valuable information about the early childhood workforce in Oklahoma such as turnover, number in the profession, credentials and

http://www.okregistry.org/




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professional development needs. The data will be used to streamline and target resources to improve the quality of child care by improving the professional development of early childhood teachers.

Oklahoma Child Support Services Business Intelligence software project Founded by International Data Group (IDG) in 1988, The Computerworld Honors Program is governed by the not-for-profit Computerworld Information Technology Awards Foundation. Computerworld Honors Program is the longest running global program honoring individuals and organizations visionary applications of information technology that promote positive social, economic and educational change. Our technology partner, Information Builders, submitted the OKDHS-Oklahoma Child Support Services WebFOCUS technology project as a nomination for the 2012 Laureate award. OKDHS-OCSS received this prestigious award on June 4, 2012. The OKDHS-OCSS WebFOCUS project was a joint effort by Data Services Division (DSD), and OCSS to include both business users and the Center for Systems & Information Technology and Northrop Grumman (NG) staff. The project scope was to acquire and install new hardware and software to support the proposed technology solution recommended by NG, develop OCSS-OSIS data extracts to populate five years of historical data into a new data warehouse, develop a data warehouse model, and develop multiple reports with numerous report views for OCSS managers and staff. This effort was completed in late 2011 and released to staff in early 2012. The OCSS data warehouse allows managers and staff to view both historical trends and current federal performance compliancy. Numerous views are offered at the state wide, regional, office and worker levels. Views can also be sorted by various dates including annual, rolling 12 months, quarterly or monthly. The reports provide information on how an office or worker compares to the federal performance standards and identifies cases that need an action to comply with the federal benchmarks. These reports and numerous views are expected to help staff better manage time and focus attention on cases needing actions. This versatile product allows staff to keep a close eye on work product and also allow their managers the ability to monitor performance areas and adjust their work force direction and efforts as needed. Automated Interception of Out-of-State Unemployment Benefits OCSS expanded, with the completion of a federal grant project, its unemployment offset process to automatically include intercepts from unemployment agencies in other states. The automated matching and document production saves workers time and effort, increases reliable monthly collections on difficult interstate cases and improves outcomes for Oklahoma families. Oklahoma Tax Commission Statutory change The state tax refund offset process was fine-tuned by a legislative change that required no programming or staff time to implement, and saves OKDHS - OCSS $150,000 annually. The law was effective November 1, 2012. Modernization of Data Exchange Agreements OCSS is seeking updated agreements and data exchanges with the Oklahoma State Department of Health, Department of Corrections and Health Care Authority. In each case the data request will increase the effectiveness of child support efforts to provide reliable support to families. In addition,




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OCSS is anticipating that improvements in the data exchange will also benefit other divisions of OKDHS in their program administration. State Disbursement Unit Vendor Change OCSS used the opportunity of an expiring vendor contract for its payment processing operations to improve the overall process and restructure responsibilities. In evaluating and awarding the contract to a nationally recognized leader in state disbursement unit (SDU) operations, OCSS will save an estimated $600,000 annually while improving customer service. The reassignment of the previous SDU task of processing new child support applications to another part of OCSS will save an additional $60,000 per year. Federal Interoperability Grant Oklahoma OKDHS was awarded the federal Office of Child Support Enforcement (OCSE) interoperability grant. The goal is to complete this grant project during the next year. The outcome of the project is the technology roadmap for how state agencies can better share information and allow for more efficient processes to better serve our customers through shared technology. All Payments Electronic In 2013, OCSS will complete a project converting all remaining paper warrants to electronic payments. Federal Data Warehouse Grant OKDHS OCSS was awarded a federal data warehouse grant. In 2013, OCSS will design, create a data model and conduct a proof of concept test for the federal OCSE. This data warehouse model will be used by the federal OCSE to offer to other states for data warehouse standardization Automation of Data Exchange OCSS, in 2013, will complete an OCSE federal grant project to automate a data exchange between the State of Texas and Chickasaw Nation IV-D programs and the Oklahoma Tax Commission to intercept past due child support debt. This project will bring in additional collections for families. Strategic Planning Initiative In 2012, OCSS won the Governor’s Oklahoma Quality Crown Award for its efforts in strategic planning. OCSS has a long tradition as one of the OKDHS divisions to do regular strategic planning. Organizational goals and objectives are established by strategic planning; however, the process was undocumented, time consuming and difficult to manage. In 2009, the OCSS director issued a directive for the OCSS standing committee “Quality Council” to improve the existing strategic planning process and to ensure it would be continuous and inclusive. The Quality Council responded by creating a sub-group it named SPEAR (strategic planning, evaluation, accountability and reporting). SPEAR created a comprehensive planning and evaluation process that provided structure, but was flexible enough to allow for continuous improvement. OCSS used the new process to develop the current strategic plan.




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Specific Government Modernization that has resulted in better services for citizens or less burden for businesses Supplemental Nutrition Assistance Program (SNAP) In 2009 OKDHS changed the SNAP food benefit issuance date from the first of the month to three staggered issuance dates on the 1st, 5th, and 10th of the month. The change allows clients access to and the 3,200 participating retailers to stock, more fresh fruits and vegetables. It also eliminated bare shelves at the end of the day, which benefits not only clients but provides more stock for the general public. Farmers Market/Senior Farmers Market The Electronic Payments Systems unit of Finance along with ASD, the Oklahoma Department of Agriculture and the Kerr Foundation recruited farmers markets from around the state to bring SNAP or Senior benefit purchases to local markets via EBT. Oklahoma is the first state in the nation to handle senior benefits through an EBT card format. From April to September 2012 there were 4100 separate EBT transactions made by seniors totaling over $70,000. This money went back into Oklahoma communities and local farmers’ pockets. It also allowed low-income seniors to purchase fresh local produce. Long-Term Care Ombudsman The Office of the State Long-Term Care Ombudsman ceased printing long-term care facility inspection reports from the Oklahoma State Department of Health (OSDH) at the beginning of fiscal year 2012. This became feasible only after OSDH made all inspection reports for nursing homes, assisted living centers and residential care facilities available online. This change has resulted in savings in personnel hours for printing, filing and the cost of paper and toner. Previously, hard copies of the reports were maintained and shared as part of the Ombudsman program’s role as advocate and information source for long-term care facility consumers. Child Care Provider Website In an effort to provide real-time information, OKDHS partnered with Xerox State and Local Solutions to develop a provider website. A child care provider focus group from around the state provided input and helped test the system prior to implementation. The system allows child care providers to see authorizations, children in attendance and payment information in real time. This saves providers the time of calling for information or waiting on confirmations in the mail. Future enhancements include the posting of provider notices, eliminating the need and cost of mailing. Financial System Improvements OKDHS has operated a system to electronically process employee travel claims since 1999 called “Speed-e-Travel.” This system was updated in a very short timeframe to interact with the Trip Optimizer system and allow staff to comply with the requirements of HB 1035 (2011) while maintaining efficient electronic processing. OKDHS has built and written several uploads that take large electronic invoices from vendors such as AT&T and Centrex and convert those electronic invoices into the detail entry for payment with very little staff time and has created interfaces for electronic submission and payment of invoices in the integrated financial system.




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Lastly, OKDHS has developed processes within the integrated financial system to automate and streamline the process of gathering data and documenting efforts on federal programs in order to appropriately allocate expenses to federal grants. Movement of Benefits to Electronic Delivery The OKDHS Finance Division is currently working to move all benefit delivery to either Electronic Funds Transfer or benefit cards by July 2013. OKDHS identified all payment methods and grouped them according to payment streams called funds. These funds span all OKDHS divisions and units and are related by the manner in which the payments are made. Of the 17 OKDHS funds identified, seven are currently 100 percent electronic. OKDHS expects to have all 17 OKDHS funds moved to electronic delivery by July 1, 2013. Previous electronic payment initiatives are saving at least $5 million per year in administrative costs.

What steps has the agency taken to cut costs and/or eliminate waste? Are there efforts that have been successful which you believe could serve as a model for other state agencies seeking to keep costs minimal?

AGING SERVICES DIVISION Adult Day Health Electronic Benefits Transaction (EBT) initiative As described earlier in this document, the Aging Services Division (ASD) EBT initiative was supported by adult day services providers and has not only modernized, but has also streamlined the processing of claims payment and reporting for the adult day health program. This initiative was recognized with a state award and a multi-divisional team has further refined program processes by incorporating the Lean Six Sigma methodology. Legal Services (LS) Reporting Improvement initiative As described earlier in this document, the ASD LS developer is streamlining the assessment process for legal services by incorporating a singular tool that will be used by all 11 Area Agencies on Aging (AAA). Oklahoma Aging Advocacy Leadership Academy (OAALA) program ASD was the recipient of a prestigious national award in FY2013 for its Oklahoma Aging Advocacy Leadership Academy (OAALA) program. The National Association of States United for Aging and Disability (NASUAD) honored OAALA with its “Excellence in Volunteer Services Award” in Washington, D.C. OAALA identifies, trains and develops volunteer leaders to advocate on aging issues and to effect social change related to aging. With volunteer change agents who know and understand the aging and disabled population, older Oklahomans and those with disabilities know they have committed leaders to advocate successfully for their unique needs. The program is largely sponsored through a partnership with the Choctaw Nation. Aging & Disability Resource Consortium (ADRC) initiative As described earlier in this document, ASD ADRC initiative will grant consumers better access to needed services, support for long-term care and help with living in the community independently via a centralized information web portal system.

http://www.nasuad.org/




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Waiver Management Information System (WMIS) redesign As described earlier in this document, the Aging Services Division (ASD) is redesigning the management information system currently used to administer the ADvantage program. The services provided to every ADvantage consumer must be authorized by OKDHS and it is through this system that the tracking and authorization of services occur. More than 20,000 people each year rely on these services as an alternative to nursing home care. The redesign will also include a new provider portal access for service delivery providers’ that virtually eliminates the transmittal of paper documents by mail or fax, thus improving the delivery of services and creating greater process efficiency. It will also improve quality assurance and reporting functions that will enhance quality and accountability.

Disaster Recovery Contract

In the fall of 2011, the scope of the information technology recovery services contract with IBM was reduced and consolidated with OMES and CompSource into a statewide recovery contract.

Child Welfare Services Child Welfare Services Vertical Integration Several efficiencies are being realized through reorganizing child welfare from the two division approach of a policy division devoted to child welfare policy and a field division where front line staff were devoted to a specific program area in either child welfare or family support services and a leadership team assigned responsibilities to both program areas. Now there is a singular focus of child safety from the front line staff to the top of leadership, no more competing priorities between the two program areas pulling for leaderships time and effort, a more simplistic organizational structure allowing front line staff more access to leadership, and a leadership team that contains only leaders with child welfare knowledge and experience. Child Welfare Workforce: Competent and Committed Child Welfare Services experiences high turnover rates for child welfare staff, hiring and training approximately 500 each year. The costs to onboard and train new staff are high not only in dollar amounts, but more importantly, the impact on children and families. Research shows every time a worker changes, the child and family’s time to reunification or adoption slows tremendously, leaving the case open for months longer than necessary. This toll on families and the system will be curbed by new hiring, training, and retention strategies. Assessments will be conducted for new hires that will improve the selection process. Upon completion of training, new staff are now required to pass competency exams before being assigned a workload. If they fail the test after two attempts, they are not retained. Supervisor to worker ratios of 1:5 will improve supervision and support to front-line staff thereby improving the quality of work and experience working with children and families. In 2013, a new field training program is available for all front line staff with assigned mentors guiding them in the field through their first 90 days after the initial classroom training. In 2012, child welfare staff received the first 5-year incremental increase in their salary that will eventually bring them to a competitive regional salary. Through these efforts, retention of child welfare staff will improve so significant progress can also be made on reducing caseloads. Adding newly allocated staff is important and will make a difference, but retaining the staff and ensuring they are competent and committed to the work will have a large impact on caseloads. By June 30, 2014, the caseload standards must also be reached for front-line staff so the work is more manageable.




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Centralized Hotline As part of the settlement of a class action civil rights lawsuit against OKDHS, the agency has implemented the Oklahoma Pinnacle Plan, the improvement plan for child welfare services. Along with agency restructuring and an increase in the number of child welfare workers, the settlement also includes efforts to provide quicker response times to abuse calls to the statewide abuse and neglect hotline. In 2009, legislation amended 10A O.S. § 1-2-101A and required OKDHS to create a centralized hotline for reporting child maltreatment. By January 2012, the hotline was accepting calls statewide and making standardized screening decisions previously left to each county office. Response time to calls placed to the statewide abuse hotline and the recurrence of long wait times is gradually dropping. Data concerning incoming calls to the hotline was collected from April 30, 2012 to Dec. 2, 2012. The average time to answer an incoming call fluctuated from a low of 59 seconds to a high of six minutes and 23 seconds. A review of the longest wait times for callers helped OKDHS determine the relationship between incoming calls and staff levels at a given time. Once all data is reviewed, OKDHS will assess whether the data indicated the cause of long wait times to be a process issue, an understaffing issue or an anomaly. It will also help OKDHS take steps to reallocate personnel if necessary.

CHILD SUPPORT SERVICES Consistent Excellence initiative For 2012, Oklahoma Child Support Services (OCSS) will continue its Consistent Excellence Initiative, a statewide project to find and implement best practices. With over 200,000 open cases, OCSS staff knows that only by sharing tried and proven strategies and procedures can the program hope to offer the best possible service to so many deserving Oklahoma families. Committees involving subject matter experts, caseworkers and program attorneys have been formed to solicit best practices from all areas served by the statewide program, which will then become standard operating procedures to be implemented across the state. OCSS Automation of IRS Confidentiality Training Since OCSS has access to confidential Internal Revenue Service (IRS) information, the division is required to assure strict compliance with IRS protection of information. Previously, each employee was required to watch a video, sign an affidavit and send it into a central reporting person. The process is now automated and all training is done on-line and training records are kept easily accessible and retained electronically. This automation has allowed for a reduction in cost and compliance. Bond Issue Refinancing OKDHS began the process of refunding the 2000 and 2002A Bond Series in 2012. Doing so will save the agency approximately $669,378 in interest costs, which will be re-invested in a new bond series to fund $10 million in new projects. Debt service on the new bond will not exceed the current budgeted debt service. Additionally, the new bond will be paid off in 11 years, rather than the typical 15 years. Imaging Client Records OKDHS staff handles millions of pieces of client paperwork each year and continues to look for ways to reduce the amount of paper being generated and stored. The effort to store files electronically allows staff to minimize or even reduce the need for additional file storage and reduces the time spent requesting duplicate documentation or searching for misfiled documents. OKDHS AFS files are now 100% digital except for historical archives which are being scanned or aged out of the system. A decentralized scanning process was implemented that allows any office serving clients to immediately




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upload a document and index it to a client's online record in real time. Additionally, in December, 2012 the OKDHSLive website allows a client to upload a document securely to their file from any site with internet access. OKDHS also continues to experience reductions in paper usage (over 3,300 fewer cases of copy paper in FY 2012 vs. FY 2010) in spite of higher client numbers. Postage Due to initiatives such as address cleansing, reconsideration of the necessity of certain client notifications, and improved mail size management, OKDHS is sending nearly 1.5 million fewer pieces of mail and has maintained a nearly constant postage budget, in spite of continual United States Postal Service postage increases. Additionally, the OKDHS mail manager was recognized by the Greater Oklahoma Postal Customer Council as the 2010 Mail Manager of the Year for his efforts to maximize his postal budget, reduce “bad address” mail, and keep abreast of ever-changing postal requirements. Multi-Function Printer Contract OKDHS was able to use the usage information gathered from its prior multifunction printer (print, copy, scan, and fax) contract to reduce the number of printers under the new contract and to leverage its volume to help the state negotiate a more favorable rate on its new statewide agreement for multifunction printers. OKDHS is currently the only agency that pays for its multifunction printers on a cost per copy basis. The revised contract is saving $400,000. Personal Computer Self-Maintenance PC self-maintenance eliminated third party support for out-of-warranty devices, assumed self-maintenance, redeployed/repurposed devices, and saved $500,000 in the last two years. LiveMeeting Use of LiveMeeting eliminated a contracted service, brought functionality and administration in-house via Microsoft LYNC, and created $45,000 in savings annually. Software Licensing Audits Audits of software and hardware maintenance contracts to eliminate excess licenses and right-size maintenance/support service levels. Example: VOCUS: eliminated service for a $50,000 savings annually. Lean/Six Sigma Process Improvement Projects

Procurement Paradise – The IT procurement process was streamlined to eliminate non-value added steps, enhance flow and ensure stability and compliance. Average total time for internal contract award was reduced from 58 days to 19 days.

Clearance Level – AFS data exchange discrepancies were not being verified and applied to ongoing eligibility decisions within the required 30 day time period 15percent of the time. This process was analyzed, wasted steps were removed, and flow within the process was increased to allow for the timely and efficient verification of income eligibility data.

SLAM (Stream Lining Access Management) – The process used for employees to get appropriate system access caused delays in obtaining the access, rework and lost productivity. The process was documented in detail with bottlenecks and redundancies identified and removed, efficiencies realized, and staff made more aware of the security process.

The Huddle – AFS training content and delivery for field staff was based on requests from the field thereby making it unpredictable due to inconsistent involvement of key staff in some AFS sections. The results were unreliable or incorrect delivery of benefits to customers of OKDHS seeking




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assistance from inconsistently trained personnel. The AFS training process was documented, analyzed and improved to ensure consistency and accuracy.

OTHER (Offer-to-Hire Enhancement Research) Team – The length of time and complexity of the hiring process had resulted in the loss of potential hiring candidates – causing delays and rework in filling positions. The hiring process and associated data were analyzed, improved and standardized. Edits were implemented to reduce errors in the data; improvements were made in the human resource system to enhance workflow; manual forms were automated thereby reducing the waste of motion; and users were adequately trained to use the enhance system.

CORE MISSION: What services are you required to provide which are outside of your core mission? Are any services you provide duplicated or replicated by another agency? Are there services which are core to your mission which you are unable to perform because of requirements to perform non-core services elsewhere?

Adult and Family Services (AFS) The AFS mission is to partner with our stakeholders to ensure program and fiscal accountability by:

• Developing clear, concise policy for staff and providers; • Providing training for staff and providers; and • Monitoring and evaluating service and benefit delivery.

The AIDS Coordination and Information Services (ACIS) is a comprehensive psycho-social-medical case management program for individuals and families living with HIV/AIDS. Case managers coordinate services to meet both social services and psychological/medical needs of OKDHS clients. Included is an assessment for all services accessible through OKDHS, access to medical care and treatment, eligibility & access to prescription assistance programs, insurance premium and co-pay assistance, Social Security Disability, linkages to legal services, housing assistance, and HIV home health assistance. Services are either provided directly or arranged and coordinated by ACIS staff, meeting the agency mission helping people living with HIV/AIDS live safer, healthier, more independent and productive lives. ACIS is uniquely different from other HIV case management programs. There are no income or resource limits required to qualify for ACIS case management. Other HIV case management programs are federally funded through Ryan White Part B and are limited to serving only individuals 18 years of age or older whose incomes are at or below 200% the Federal Poverty Level. This excludes many working individuals and families who would be left without access to medical care and treatment because of the low-income eligibility cap for Ryan White funded case management. Additionally, the ACIS case management program is the only single program that covers all 77 counties in Oklahoma. There are no services which are core to our mission that go unmet. ACIS staff are charged with identifying, arranging, and following-up on all needed services by the HIV/AIDS clients being served. The responsibilities of ACIS staff regularly involve interacting with the medical community, legal services, pharmaceutical companies, insurance programs, Social Security Administration, Immigration Services,




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the Oklahoma State Department of Health, the Department of Corrections, and Adult Protective Services. Adult Protective Services (APS) protects vulnerable adults from abuse, neglect, self-neglect or exploitation. For APS, protection of persons with mental illnesses is limited because of the lack of community-based services and limited state dollars to meet the needs of that population. The Child Care Subsidy Program helps low-income parents pay for child care, which allows them to work and/or complete their education or training. Child care is also provided in critical situations to help prevent neglect, abuse or exploitation of children. Only licensed and contracted child care homes and centers are eligible to participate in the Child Care Subsidy program so that children in families with low incomes receive quality care. Providing quality child care services assures each child in care has the opportunity to develop, learn and grow in a positive environment. The Low Income Home Energy Assistance Program (LIHEAP) provides winter heating, energy crisis, and summer cooling assistance to eligible low-income households during specific application periods throughout each year. An allocated percentage of LIHEAP funds are provided to the Department of Commerce for weatherization services activities. Low-income and vulnerable households are then able to apply the share of their monthly household income that would have been applied to their energy bills to other immediate or critical needs. The Oklahoma Health Care Authority (OHCA) and OKDHS share Medicaid eligibility determination, though currently there is very little overlap in this service since this is provided for separate and distinct Medicaid populations. OKDHS determines Medicaid eligibility for the aged, blind, and disabled population. This helps ensure underserved and vulnerable populations have access to health care. There are no services we are required to provide which are outside the core mission. OKDHS receives federal Title V block grant funds to administer the Children with Special Health Care Needs (CSHCN) program. State law requires that CSHCN be housed at OKDHS but in most states this function is through the state health department. The Supplemental Nutrition Assistance Program (SNAP) ensures that individuals and families in need are better able to meet their nutritional needs. Temporary Assistance to Needy Families (TANF) ensures individuals and families in need are able to move toward self-sufficiency through better employment opportunities and overcoming obstacles by promoting job preparation, work and marriage; prevent and reduce out-of-wedlock pregnancies; and, encourage the formation and maintenance of two-parent families. Oklahoma state law requires OKDHS to collaborate with Oklahoma Employment Security Commission, Department of Commerce, State Department of Health, State Department of Education and other state agencies as appropriate in administering the TANF program and reaching its goals. The State Supplemental Payment program is mandated to be in OKDHS and no other agencies duplicate this program or have expressed an interest in taking over this service. OHCA has expressed interest in administering Medicaid for this population, but not the requisite money payment and according to federal law the two cannot be separated.




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Some states may have multiple agencies delivering TANF, child care quality and/or licensing and Child Care Subsidy but Oklahoma has reduced this redundancy by operating all three programs through OKDHS.

Aging Services Division

OKDHS Aging Services Division (ASD) is responsible for 17 major programs, all of which are part of its core mission. Beyond the 17, the division is involved in other related initiatives such as Grandparents Raising Children (GRC), Prisoner Reentry, Minority Aging, and the Oklahoma Aging Advocacy Leadership Academy (OAALA) referenced previously. Additionally, the division operates a large number of grant funded programs. None are duplicated or replicated to any sizeable degree and some programming results in cooperative agreements with fellow state agencies (Oklahoma Department of Commerce, Oklahoma Health Care Authority, Oklahoma Insurance Department, etc.). The division is not currently in the position of being unable to offer required programming at the sacrifice of offering non-core services.

Children Welfare Services

Child Welfare Services Prevention and Protection Unit conducts statutorily required Child Abuse and Neglect Information System (CANIS) checks of private adoptive parents to assist the court in determining whether the prospective adoptive home is safe for the child.

The Child Welfare Services Administrative Services Unit is designated by the Oklahoma State Bureau of Investigation as the agency responsible for processing all private adoption and child care-related national criminal background search requests based on fingerprints. Although these services are provided for non-OKDHS-involved children, the service falls within the agency's core mission and strategic plan of helping individuals and families in need help themselves lead safer, healthier, more independent, and productive lives and providing services that support and strengthen the family and protect its members. The Technology and Governance Unit fulfills many requests to provide statistical reports for outside entities. A possibility for duplication exists in the OKDHS Independent Living Program in the following areas: (1) life skills assessments and instructions; and (2) career exploration and career exposure. Life skills assessments are utilized by the Oklahoma State Department of Education (OSDE) for youth with an Individualized Education Plan (IEP). In many of the school districts, the same life skills assessment (Casey Life Skills Assessment) is utilized by the OSDE and OKDHS. For youth receiving independent living services through OKDHS, seminars and workshops are provided that include career exploration and career exposure. These skills can also be accessed by referring to other state agencies such as Oklahoma Department of Commerce and Oklahoma Department of Rehabilitative Services. The agencies are aware of these potential duplications and both the Governor’s Youth Council on Education and Economic Development and the Statewide Transition Work Group, consisting of representatives of state agencies and local community providers, are meeting to refine processes to avoid duplication and maximize service delivery. Foster care services are replicated for children in OKDHS custody as contracted out by OKDHS. Adoption services are provided by private agencies that do not provide services to children in OKDHS custody. OKDHS may contract with a private agency to provide supervision for a trial adoptive family that resides out-of-state or out of the country and contracts out some services for interstate compact on the placement of children (ICPC) adoptive processing and ICPC case monitoring.




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There are services that require supports by contractors but none that can't be performed because of non-core service requirements. For example, permanency planning specialists have difficulty performing some of the identified services or supports for their independent living age youth because of the other core service demands for the families and younger children on the caseloads. To ensure the independent living youth receive the services they need, the independent living program contracts with the University of Oklahoma National Resource Center for Youth Services to provide a portion of the independent living services to accomplish meeting the core mission of independent living.

Developmental Disabilities Services Division

The mission of the Developmental Disabilities Services Division (DDSD) is to design and operate a service system centered around the needs and preferences of citizens with developmental disabilities by: enabling persons with developmental disabilities to lead healthy, independent, and productive lives to the fullest extent possible; promoting the full exercise of their rights as citizens of their communities, state, and country; and promoting the integrity and well-being of their families. DDSD operates the Home and Community-based Waiver services programs. These programs furnish an array of services that assist eligible individuals to live in the community and avoid institutionalization. In Fiscal Year 2012, Home and Community-based services helped 5,051 Oklahomans with developmental disabilities receive services in community settings. We do not provide duplicate services provided by other entities or agencies.

Oklahoma Child Care Services

Oklahoma Child Care Services (OCCS) is not required to provide any services which are outside of their core mission. OCCS does not provide any services that are duplicated or replicated by another agency. There are no services that are core to the OCCS mission which they are unable to perform because of requirements to perform non-core services.

Oklahoma Child Support Services

Oklahoma Child Support Services (OCSS) has a number of core functions that we are obliged to perform under the mandates of Part IV-D of the federal Social Security Act and applicable state laws and regulations. These include establishing and enforcing paternity and child support and medical support orders and collecting arrearages. No other state agency provides these functions. There are many secondary functions that aid us in these efforts and that we are encouraged to work with other entities to pursue, such as establishing referral networks for customers with community agencies and services, but these are not strictly part of our core functions and do not interfere. Our largest impediment to fulfilling our core obligations is lack of adequate resources to meet the needs of customers; OCSS has more than 200,000 cases that need our assistance, but our resources are only sufficient to provide one caseworker for every several hundred cases that need our help.

PRIVATE ALTERNATIVES: Are any of the services which are performed by the agency also performed in the private sector in Oklahoma? In other states? Has the agency been approached by any foundation, for-profit or not-for-profit corporation with efforts to privatize some of the functions of the agency?




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Adult and Family Services

OKDHS Community Adult Protective Services is the only social service agency that investigates abuse, neglect, and exploitation by family caregivers outside of nursing facilities. OKDHS APS Long Term Care staff are tasked with investigating all types of abuse, neglect, and exploitation by staff in nursing facilities. Other types of services and investigations are completed by the Oklahoma State Health Department, the ombudsman from the Office of Client Advocacy, and the State Attorney General’s office. The Oklahoma State Health Department only investigates facilities policy questions related to abuse, neglect, or exploitation. (For instance, whether policy exists and facility trained staff in policy.) The ombudsmen are advocates for nursing facilities’ residents and are not investigators. They are there to ensure that the residents are satisfied regardless of whether abuse, neglect, or exploitation exists. They only respond to the will expressed by residents. The Attorney General only investigates criminal abuse leaving a wide array of uninvestigated problems. Some states contract with private non-profit agencies to provide adult protective services. These states have inconsistent response and services are not uniform. Training and investigations are left to the local area and vulnerable adults are left at risk. Thirty four (34) states have APS programs similar to Oklahoma’s model. OKDHS funds or partially funds several community programs using the Children with Special Health Care Needs (CSHCN) portion of the Title V block grant; including the Oklahoma Family Network, the Oklahoma Infant Transition program and several other programs at the University of Oklahoma Health Sciences Center (OUHSC). In the past, the State Department of Education, the Oklahoma Family Network and SoonerSUCCESS program (at OUHSC) have been interested in administering CSHCN funds. However, there is currently no duplication of CSHCN services with others. Numerous private and public agencies have expressed interest in determining Medicaid eligibility but each group is interested only in distinct subsets of the Medicaid population. One of the major barriers to this is building a computer system that feeds eligibility into the Medicaid Management Information System (MMIS) which federal law requires to be with one entity in the state (OKDHS in Oklahoma). There are numerous private and public entities that provide the same case management services we do for the Medicaid population; for example Area-wide Aging, Community Action Program, Oklahoma State Health Department, and Head Start. It is a federal requirement that only staff protected by a state merit system perform eligibility determination functions for SNAP. SNAP coordinates with other agencies/non-profits to provide food assistance to low-income families; for example, the Regional Food Bank of Oklahoma and the Community Food Bank of Eastern Oklahoma. SNAP contracts with Oklahoma University, Oklahoma State University and the Chickasaw Nation to provide nutrition education to recipient families using federal funds specifically allocated to OKDHS for this purpose. OKDHS is the designated agency for administering the TANF block grant and has never been approached by any public or private organization as an alternative. OKDHS has contracts and/or agreements with the Oklahoma Department of Mental Health and Substance Abuse Services, Department of Libraries and State Department of Education for Literacy, GED, ESL and Adult Basic Ed classes; Department of Career and Technology and Higher Education for education and training; and contracts with other public




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entities to provide services to community needy persons. OKDHS also contracts with the private sector for some services; for example, the Regional Food Bank, Whiz Kids and the Boys and Girls Club for youth mentoring services; and, Public Strategies, Inc. for family formation services. However, all contract and agreements were reduced last year due to budget deficits. Some states contract out overpayment collections for SNAP, Child Care Subsidy and Medicaid to private collection agencies. AFS has not been approached by outside entities with efforts to privatize the division’s functions. There are limited private non-profit agencies that provide HIV case management but they are restricted to serving individuals whose income is at or below 200 percent of the federal poverty level. All states and territories receive Ryan White funds for case management; however, these funds are geographically limited to the state of the grantee of record. OKDHS has not been approached by any foundation, for-profit, or non-profit corporation or agency seeking to privatize HIV case management services because it would not be cost-effective for them to do so.

Aging Services Division

The majority of Aging Services Division services are already delivered through contracts with private entities, many of which are not-for-profit. Approximately 94 percent of all aging network services are offered through this medium and the division works with nearly 800 contractors. Examples would include the Area Agencies on Aging, adult day health providers, and ADvantage providers. In terms of potential for additional privatization, the division continues to look for ways to lesson contractor reliance on OKDHS funding. This would help with sustainability and fiscal strength and ultimately help the providers and those we serve in the network. There are many divisional examples of private entities helping support key initiatives, like the example given with the Oklahoma Aging Advocacy Leadership Academy (OAALA).

Children Welfare Services

Public and Private partnerships are being expanded to support children and families involved with the child welfare system. Collaboration with the OKDHS office supporting faith-based and community initiatives and other external partners, the CWC will finalize a two-year strategic plan focused on recruitment and support of resource families. The 111 Project and Count Me In 4 Kids have been implemented with the Office of Faith-Based and Community Initiatives (OFBCI). Submissions from private agencies have been received in response to an OKDHS request for proposal for partnerships in recruitment, retention and support for non-relative resource parents and treatment foster homes. Anticipated award date for the successful vendors is February 1, 2013. The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is partnering with OKDHS to increase the number of children involved in child welfare services who are also served through Systems of Care.

Developmental Disabilities Services Division Private for-profit and not-for-profit agencies currently provide all of DDSD’s direct services, including services identical to those provided at the Northern and Southern Oklahoma Resource Centers. In the past, there has been interest in privatizing the services at NORCE and SORC. Due to the size of the facilities and number of full-time employees, the terminal leave cost and severance packages for state employees was cost prohibitive.




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Oklahoma Child Care Services The private sector does not perform any of the licensure services that Oklahoma Child Care Services (OCCS) perform. OCCS has many contracts with not-for profit entities and educational institutions that extend their services which are core to their mission. No foundation, for-profit or not-for-profit corporation has contacted OCCS regarding privatization.

Oklahoma Child Support Services

Oklahoma Child Support Services (OCSS) serves all 77 counties in our state through a network of 42 local and specialized offices. As our staff is made up of licensed Oklahoma attorneys and caseworker/paralegals, we have the ability to seek remedies in all district and administrative courts throughout the state, as do any other Oklahoma attorneys. Although our work is highly specialized, a customer can hire an Oklahoma attorney to collect their child support, usually for a fee or for a percentage of from one-third to one-half of the collections. However, certain enforcement remedies and access to information in federal and state databases about income and location of parties to child support cases are limited to child support agencies, like OCSS, operating under Part IV-D of the federal Social Security Act V-D and, in some instances, the agencies’ contracted vendors. These include financial institution data matching (FIDM), state and federal tax refund intercept, passport denial, new hire reports, unemployment matching and offsets, lottery offsets, mandatory matching on workers compensation and personal injury claims, credit bureau referrals , and employment records from all states. OCSS also has the ability to do interstate and international case processing with other IV-D programs. In 13 offices, services are provided by district attorney staff through a contractual arrangement, in two other offices we provide services through private vendors, and one OCSS local office is operated by a community action program. We also work through cooperative arrangements with the University of Oklahoma Center for Public Management to run some of our special projects such as our statewide call centers for customers and their employers, and private vendors operate some other specialized projects such as our State Disbursement Unit. OKDHS has been approached by private vendors and non-profits who seek to run some portion of our operations from time to time and evaluations are made on a case-by-case basis to such proposals. The limitations federal law place upon the ability of private vendors to access remedies and information under the Social Security Act are always a concern when considering contractual arrangements instead of utilizing regular state resources. There are also nine sovereign tribal nations located in Oklahoma that provide child support services under Title IV-D of the Social Security Act. OCSS works with these tribal IV-D programs to ensure no duplication of effort.

Documents

AGENCY MISSION STATEMENT - Oklahoma Senateappropriation.oksenate.gov/SubHuman/Agencies/2013/FY14... · 2013. 1. 17. · AGENCY MISSION STATEMENT: We help individuals and families